NGS确诊结核性脑炎1例报告并文献回顾  

Literature review and a case report of tuberculous encephalitis diagnosed by next generation sequencing

作　　者：肖灵辉 谭华斌 杨军杰 钟炎平 毛静 刘鑫华 李姗 刘园园 雷旭 刘龙 谭华炳 XIAO Ling-hui;TAN Hua-bin;YANG Jun-jie;ZHONG Yan-ping;MAO Jing;LIU Xin-hua;LI Shan;LIU Yuan-yuan;LEI Xu;LIU Long;TAN Hua-bing(Department of Infectious Diseases,Hepatology Institute,Renmin Hospital,Hubei University of Medicine,Shiyan 442000,China;不详)

机构地区：[1]湖北医药学院附属人民医院感染性疾病科肝病研究所,十堰442000 [2]房县白鹤镇卫生院内科 [3]国药东风花果医院内科 [4]锦州医科大学十堰市人民医院培训基地 [5]随州市中心医院(湖医药学院附属随州医院)感染性疾病科

出　　处：《医学动物防制》2022年第12期1128-1131,F0003,共5页Journal of Medical Pest Control

基　　金：国家自然科学基金青年科学基金资助项目(82002149);2021年十堰市科学技术研究与开发项目计划(2021K65)。

摘　　要：目的提高对临床极少见的结核性脑炎(tuberculous encephalitis,TBE)认识,提高对TBE诊治水平。方法分析1例以“高热12天”住院的53岁男性患者诊治经过。经抗菌素治疗5天后,发热变为中度,但出现头痛,无恶心、呕吐,无颈项强直、脑膜刺激征,无病理征,结核菌素纯蛋白衍生物(tuberculin purified protein derivative,PPD)皮试、结核抗体(tuberculosis antibody,TB-Ab)、T-SPOT.TB均为阴性,脑脊液压力高,脑脊液化验蛋白升高、糖和氯化物降低,脑脊液涂片病原学阴性;MRI平扫加增强提示脑实质多发感染病灶;脑脊液下一代测序(next generation sequencing,NGS)检出结核杆菌。临床和病原学诊断为结核性脑炎,临床治愈出院。结果TBE临床极少见,确诊困难,预后差。早发现、早诊断、早治疗是改善预后的关键。但传统检查方法涂片结核杆菌检查、PPD皮试、TB-Ab检查、TSPOT.TB检查方法阳性率低,不利于早发现、早诊断、早治疗。结论脑脊液下一代测序在TBE临床诊断和病因学诊断上有重要作用。Objective To improve the diagnosis and treatment level of tuberculous encephalitis(TBE)by improving the understanding on TBE,a disease rarely seen in clinical practice.Methods A 53-year-old male patient hospitalized for“high fever for 12 days”was analyzed.The fever became moderate after a 5-day antibiotic treatment,and it was developed into the headache without nausea,vomiting and neck stiffness and meningeal irritation sign and pathological signs,all the indexes including the tuberculin purified protein derivative(PPD)skin test,tuberculosis antibody(TB-Ab),T-SPOT.TB were negative,high cerebrospinal fluid pressure,increased cerebrospinal fluid test protein,and decreased sugar and chloride were found,and cerebrospinal fluid smear pathogen was negative.The magnetic resonance imaging(MRI)plain scan and enhancement showed multiple infection lesions were noted in the brain parenchyma;Tubercle bacillus was detected by next generation sequencing(NGS)of cerebrospinal fluid.Tuberculous encephalitis was diagnosed clinically and etiologically,and was cured and discharged clinically.Results TBE,a rare disease in clinical practices,was difficult to diagnose and poor in terms of prognosis.Early detection,diagnosis and treatment were critical to improve the prognosis.Traditional methods involving smear examination of mycobacterium tuberculosis,PPD skin test,TB-Ab examination and TSPOT.TB test were found to have low positive rate,and it wasn′t conducive for early detection,diagnosis and treatment.Conclusions NGS plays an important role in clinical diagnosis and etiological diagnosis of TBE.

关 键 词：结核性脑炎 下一代测序 结核杆菌 磁共振成像 诊断 预后 

分 类 号：R529.3[医药卫生—内科学]